APPLICATION INSTRUCTIONS Revised 07/13/18 JEFFERSON …

APPLICATION INSTRUCTIONS JEFFERSON COUNTY SHERIFF'S OFFICE

JEFFERSON COUNTY, KENTUCKY

Revised 07/13/18

A. Applicants must submit copies of the following documentation at the time a completed application is submitted:

a) Copy of high school diploma or GED Certificate . b) Copy of birth certificate. c) If applicable, a copy of military discharge form DD-214 (DD-214 must indicate "Type of

Discharge" and "Character of Service"). d) Copy of a valid driver's license.

B. Application must be received in the Jefferson County Sheriff's Office, 531 Court Place, 6th Floor, Room 605, Louisville, KY. 40202, by 4:00 PM of the filing deadline day, _______________. This includes mailed applications and all documentation listed above. We will NOT accept FAX copies of the application or the required documentation.

C. Social Security Number (item 1)--Federal Law (P.L. 93-579, section 7) requires that you be informed when asked for your Social Security Number; that this number must be provided; and that it will be used for identification purposes in the examination, employment and payroll processes.

D. Other names (item 7)--This information is requested for completion of the records check and background investigation.

E. Police Record Check Release form (page 4)--A conviction or pending criminal charge does not necessarily mean you cannot be considered. The nature of the conviction or pending charge and how long ago it occurred is important. Give all facts so that a decision can be made. Note: You cannot be considered if there is a history of a felony conviction.

F. EEOC Statistical Information (page 5) ? The Sheriff's Office abides by the principles of The Equal Employment Opportunity Commission. The Sheriff's Office requests that you voluntarily answer questions on this form relating to sex, race/ethnic group, and physical impairment. Whether or not you answer these questions will not affect your potential employment in any way.

G. The applicant is responsible for notifying this office immediately of any change of information pertinent to the application form, such as address or telephone changes.

H. Successful applicants for the position of Deputy will be required to sign a three year conditional contract of employment.

JEFFERSON COUNTY SHERIFF'S OFFICE

531 Court Place, 6th Floor Louisville, Kentucky 40202

502-574-5400

We are an Equal Opportunity Employer

Revised 06/25/15

PRINT IN INK. Answer each item completely and accurately. Incomplete answers may disqualify you or cause delays. FALSE answers

may lead to rejection of application and/or dismissal. Please write letters "NA" (Not Applicable) in those sections which do not apply to you.

1. Social Security Number

2. Title of Position (Check only one)

3. Date of Application

--

Deputy____ Reserve____ Civilian____

_____/_____/_____

If you checked Civilian you will need to state a specific position: _____________________________

4. Last Name

(Jr/Sr)

First Name

Middle Name

Address (Number and Street)

(Apartment Number)

E-Mail Address: __________________________________________

City

State

Zip Code

6. Home Phone: ( ) _____-_______ Cell Phone: ( ) _____-_______ Other Phone: ( ) _____-_______

7. List all other names, including maiden and nicknames, by which you are known or have been known. ____________________________________________________________________________________________

8. If you are applying for a Deputy or Reserve position are you age 21 or older? Yes _____ No _____

9. If you are applying for a Civilian position are you age 18 or older? Yes _____ No _____

10. Are you a U.S. Citizen? Yes ____ No____ 11. Do you have a valid driver's license? Yes____ No_____

If no, do you have the right to work in the U.S.?

If yes, in what state was license issued?________________

Yes_____ No_____

License No._______________ Exp. Date_____________

12. Education and Training: Give complete information. Have you passed a GED test? Yes____ No____ N/A____

Schools High School or G.E.D.

College/ University Business College

Graduate Work

Vocational/ Military Technical

Name & Address

Dates

From

To

Month/Year Month/Year

Month/Year Month/Year Month/Year Month/Year Month/Year Month/Year

Month/Year Month/Year

Circle Highest Grade Completed

High School

College Grad School

9 10 11 12

1234 1234

Sem. Hrs.

Major

Minor

Degree/Certificate Diploma: Please check Yes____ No____

Degree Earned

Clock Hours Weekly

Clock Hours Field of Completed Study

Degree/Diploma Certificate Earned

(circle one) Degree/Diploma

Earned (circle one)

Degree/Diploma Certificate Earned

(circle one)

13. License or Certificate: If a license, certificate or other authorization to practice a trade or profession is relevant,

please list.

Name of Trade or Profession

License No:

Name & Address of Licensing Agency

Date Issues:

Expiration Date:

14. Have you ever served in the military? Yes____ No____ If yes, submit DD-214 and complete the following: Dates: From: ____/____/____ To: ____/____/____ Branch: _____________ Rank at discharge: __________ Were you discharged in connection with a military court martial: Yes _____ No _____

15. Are you related to an employee or employees currently employed with the Jefferson County Sheriff's Office? Yes _____ No _____ If yes, please list names/relationship to you. Attach additional page if necessary.

1. _______________________/_________________

relative's name

relationship

2. _______________________/_________________

relative's name

relationship

16. Employment Experience: LIST ALL WORK HISTORY. Begin with your most recent job and describe in

detail each specific job including any military service or volunteer work you have had. Periods of unemployment should be noted. Do not leave any gaps in time sequence. It is very important that you describe your duties and responsibilities under each position listed. If you moved to a different position within the same organization in which your duties changed, describe that position as a separate job. You MUST provide this

information on the application, as resumes are not considered official information.

Most Current Employer:

Address (City, State, Zip)

Type of Business:

Employment Dates: From:

Primary Duties:

/ /

Your Position: To: / /

Salary: Starting:

Phone Number: ( )

Ending:

Supervisor's Name and Position: Reason for leaving:

Second Most Current Employer:

Type of Business:

Employment Dates: From:

Primary Duties:

/ /

Hours per week:

Address (City, State, Zip)

Your Position: To: / /

Salary: Starting:

Phone Number: ( )

Ending:

Supervisor's Name and Position: Reason for leaving:

Hours per week:

Third Most Current Employer:

Type of Business:

Employment Dates: From:

Primary Duties:

/ /

Address (City, State, Zip)

Your Position: To: / /

Salary: Starting:

Phone Number: ( )

Ending:

Supervisor's Name and Position: Reason for leaving:

Fourth Most Current Employer:

Type of Business:

Employment Dates: From:

Primary Duties:

/ /

Hours per week:

Address (City, State, Zip)

Your Position: To: / /

Salary: Starting:

Phone Number: ( )

Ending:

Supervisor's Name and Position: Reason for leaving:

Hours per week:

If additional forms for the above work history are needed, additional forms will be provided upon request.

I certify, under penalty of law, that the information given in this application is correct and complete to the best of my knowledge. I am aware that should investigation at any time show falsification, I may be excluded from consideration for employment, or if employed, I may be terminated from employment.

Signature ____________________________________ Date ______________

AUTHORIZATION FOR RELEASE OF RECORDS

I, __________________________________, hereby authorize the Jefferson County Sheriff's Office to request any law enforcement agency, former employer, or credit bureau to release all information (including, but not limited to traffic violation(s), conviction(s), pending criminal charge(s), and credit records) to the Jefferson County Sheriff's Office or its representatives that may be sought in connection with this application for employment with the Jefferson County Sheriff's Office.

A photocopy of this release shall be considered as effective and binding as the original hand-executed copy.

Social Security Number

--

Applicant's Signature ____________________________________ Date ______________

POLICE RECORD CHECK RELEASE

The Jefferson County Sheriff's Office and/or Merit Board must check the conviction records of all applicants for positions which involve care and custody of persons or handling of significant amounts of Jefferson County money or property. Under Kentucky law, a felony conviction automatically excludes applicants from employment in "non-elective, peace officer" positions. A false or incomplete answer on this and any other application form is grounds for subsequent dismissal of an employee, or for automatic rejection of the application if hiring has not been initiated.

Name: Address: City: Date of Birth: Maiden/Alias/Nicknames:

PLEASE PRINT

State: Social Security Number:

Zip Code:

List all past and pending traffic citations, criminal charges and convictions.

Date

Location (city, state)

Nature of Charge

Disposition of Charge

Have you ever been convicted of, or pleaded guilty to a felony? Yes ______ No______ I do hereby attest that all the above is correct to the best of my knowledge. In addition, I hereby authorize Jefferson County Sheriff's Office and/or Merit Board to search the criminal record for any or all convictions pertaining to me. This information is part of my application for employment.

SIGNATURE: DATE:

THIS FORM MUST BE RETURNED WITH THE APPLICATION FORM

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